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We report 3 cases of significant foam formation in the venous reservoir with the Maquet Quadrox-I oxygenator and VHK 31 000 reservoir system. All the 3 patients required maximal suction return during procedures, causing pressurization of reservoir and foam formation. Two patients experienced systemic air emboli, which were dealt with by means of retrograde cerebral perfusion and hypothermia with no neurological sequela. These events emphasize the importance of device selection in high-riskdoi:10.1093/icvts/ivu088 pmid:24706171 fatcat:i7qldsme7je7zhvxdnyttvwoqy